Healthcare Provider Details

I. General information

NPI: 1568348696
Provider Name (Legal Business Name): MIIDDLEWAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 LENOX AVE FL 1
EAST ORANGE NJ
07018-3102
US

IV. Provider business mailing address

99 LENOX AVE FL 1
EAST ORANGE NJ
07018-3102
US

V. Phone/Fax

Practice location:
  • Phone: 917-495-9783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RILWAN ADIGUN
Title or Position: OWNER
Credential:
Phone: 917-495-9783